International journal of psychiatry research, Nov 30, 2019
Background: Recent inpatient studies examining the effect of low-dose ketamine infusions in treat... more Background: Recent inpatient studies examining the effect of low-dose ketamine infusions in treatment resistant depression (TRD) have shown promising results in diminishing suicidal ideation (SI). We describe the efficacy of titrated serial ketamine infusions in stopping suicidal ideation and averting ER visits and hospitalizations in a large, naturalistic sample of adult and adolescent outpatients with TRD and complex psychiatric comorbidity in a real-world psychiatry outpatient practice. Methods: This is a retrospective chart review of 231 adults and adolescents presenting with TRD and complex psychiatric comorbidity in a large real-world psychiatry office practice with > 5400 visits/year. Each patient underwent a 60-90 min comprehensive consultation by the single treating psychiatrist. Appropriate patients were treated with 6 serial, titrated ketamine infusions (0.5-1.2 mg/kg within 40-50 min) over 2-3 weeks. PHQ-9 was obtained at baseline and before each infusion. The presence, frequency, and intensity of suicidality expressed in PHQ-9 Item 9 was analyzed over the treatment course and correlated to decrease in total PHQ-9. Suicides, suicide attempts, ER visits and hospitalizations were analyzed over the course of treatment and for an additional 4 weeks. Results: 64% of TRD patients presented with SI. There were no suicides, attempts, ER visits or hospitalizations in this large real-world cohort. SI markedly diminished in 79%, and ceased completely in 59%. Remission of SI was progressive, occurring after 1 infusion in 36%; the remainder required 3.1 infusions and an average dose of 0.75mg/kg for remission of SI. Suicidal patients experienced higher rates of response and remission of TRD than non-suicidal patients. Conclusion: This is the first report of serial titrated IV ketamine infusions in a real-world psychiatry office for adults and adolescents with TRD and complex psychiatric comorbidity to safely and rapidly treat severe suicidal ideation and avert suicide, ER evaluation and hospitalization. It represents the largest number of patients to date reported from a single site in studies of IV ketamine infusions for TRD and suicidality, and a potential breakthrough treatment option for psychiatrists to provide in the office.
comprehensive and well-integrated community-based system of psychiatric services has been develop... more comprehensive and well-integrated community-based system of psychiatric services has been developed in South-Verona since the Italian psychiatric reform. Using the South-Verona Psychiatric Case Register, we identified chronic psychiatric patients in the community over a dyear period after the reform. Six first-contact so&demographic variables (sex, age, marital status, living situation, education, occupational status) and two clinical variables (ICD-9 diagnosis and past history of state psychiatric hospital admission) were studied for these patients. Four full cohort-years of post-reform chronic patients were followed for a 2-year period to determine their subsequent patterns of care. Logistic analysis was used to examine the interaction of cohort-year with outcome and the above sociodemographic and clinical variables studied individually and in combination. We found that 36.4% of post-reform chronic patients in the community remained in long-term contact with psychiatric services for 2 years after they were first identified. Logistic analysis revealed that none of the sociodemographic and clinical variables studied individually or in combination were predictive of the probability of remaining in long-term contact with community psychiatric services.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
Purpose Anorexia nervosa (AN) is a severe psychiatric disorder, and shape and weight concerns are... more Purpose Anorexia nervosa (AN) is a severe psychiatric disorder, and shape and weight concerns are often chronic despite weight normalization. No specific treatments exist for those preoccupations that interfere with recovery and trigger relapse. A case study using a ketogenic diet followed by ketamine infusions led to sustained remission in one patient with chronic AN. Here we conducted an open-label trial to test whether this response could be replicated. Methods Five adults weight recovered from AN but with persistent eating disorder thoughts and behaviors adopted a therapeutic ketogenic diet (TKD) aimed at maintaining weight. After sustaining nutritional ketosis, participants received six ketamine infusions and were followed over 6 months. Results All participants completed the study protocol without significant adverse effects. Two participants maintained TKD for 8 weeks prior to ketamine infusions due to good behavioral response and remained on TKD. Three participants received ...
... 1-Bromobenzocyclobutene: A Convenient Entry into the Benzocyclobutene Ring System' Mark ... more ... 1-Bromobenzocyclobutene: A Convenient Entry into the Benzocyclobutene Ring System' Mark R. Decamp* and Lori A. Viscogliosi Department of Natural Sciences, University of Michigan-Dearborn, Dearborn, Michigan 48128 Received October 30, 1980 ... M.; Wojciechowski. ...
The frequent co-occurrence of alcoholism withserious mental illnesses (“dual diagnosis”)necessita... more The frequent co-occurrence of alcoholism withserious mental illnesses (“dual diagnosis”)necessitates that clinicians are able to recognize itspresence in people with disabling mental illnesses. This study demonstrates that professionals oftenmiss the diagnosis, but that their ability to detectalcoholism can be greatly enhanced by the use of asimple screening tool. Members of an urban psychosocial rehabilitation program who received psychiatrictreatment in an
Journal of the American Psychiatric Nurses Association, 2001
In the next two issues of the journal, Psychobiology Perspectives will feature content in a somew... more In the next two issues of the journal, Psychobiology Perspectives will feature content in a somewhat different area than previously covered here. We will examine the underlying biology of two sets of problematic side effects from one class of antidepressants, namely those with strong 5-HT2 antagonist properties. Although the mechanism of action of 5-HT2 antagonism has many benefits, it may also yield some untoward effects. Two of these
Journal of the American Psychiatric Nurses Association, 2001
August 2001 APNA Web site: www.apna.org 125 Editor’s Note: In this month’s Psychobiology Perspect... more August 2001 APNA Web site: www.apna.org 125 Editor’s Note: In this month’s Psychobiology Perspectives, the column turns its focus toward the management of iatrogenic effects related to antidepressant treatment. Somnolence as a consequence of antidepressant treatment is both common and potentially problematic among certain agents, namely the 5HT2 antagonists such as nefazadone, trazadone, and others. This somnolence is an early-onset, time-limited side effect but one that is often a harbinger of negative treatment outcome evidenced in self discontinuation of the medication. Such a trend toward early treatment discontinuation has implications for long-term management of depression and as such merits close attention and intervention. (1998) explored the response and discontinuation rates of newer antidepressants (e.g., nefazadone, mirtazapine, venlafaxine) as compared with agents that have been on the market for a longer period of time (e.g., tricyclics, selective serotonin reuptake inhibitors, nontricyclics). Studies in this meta-analysis included randomized controlled clinical trials in the treatment of depression. In each comparison, the author analyzed the heterogeneity of outcomes and computed the pooled odds ratio with a 95% confidence interval. The overall discontinuation rate in the newer antidepressant group was lower than that of the tricyclic group but not that of the nontricyclic and selective serotonin reuptake inhibitor (SRI) groups. Despite such findings, early-onset, treatment-emergent side effects continue to present a significant challenge to the successful completion of a given medication trial.
comprehensive and well-integrated community-based system of psychiatric services has been develop... more comprehensive and well-integrated community-based system of psychiatric services has been developed in South-Verona since the Italian psychiatric reform. Using the South-Verona Psychiatric Case Register, we identified chronic psychiatric patients in the community over a dyear period after the reform. Six first-contact so&demographic variables (sex, age, marital status, living situation, education, occupational status) and two clinical variables (ICD-9 diagnosis and past history of state psychiatric hospital admission) were studied for these patients. Four full cohort-years of post-reform chronic patients were followed for a 2-year period to determine their subsequent patterns of care. Logistic analysis was used to examine the interaction of cohort-year with outcome and the above sociodemographic and clinical variables studied individually and in combination. We found that 36.4% of post-reform chronic patients in the community remained in long-term contact with psychiatric services for 2 years after they were first identified. Logistic analysis revealed that none of the sociodemographic and clinical variables studied individually or in combination were predictive of the probability of remaining in long-term contact with community psychiatric services.
The authors critically review the literature describing the varied neuropsychiatric syndromes ass... more The authors critically review the literature describing the varied neuropsychiatric syndromes associated with systemic lupus erythematosus (SLE). Factors that have complicated the identification and treatment of affective, behavioral, and cognitive disturbances in these patents are identified, and the utility of various diagnostic interventions is examined. Finally, the authors outline the role of the consultation-liaison psychiatrist in the clinical management of the SLE patient with neuropsychiatric disturbances.
Background: Chronic anorexia nervosa is a tragic disease with no known effective pharmacological ... more Background: Chronic anorexia nervosa is a tragic disease with no known effective pharmacological or behavioral treatment. We report the case of a 29 year-old woman who struggled with severe and enduring anorexia nervosa for 15 years, and experienced a complete recovery following a novel treatment of adopting a ketogenic diet followed by ketamine infusions. Her remission has persisted for over 6 months. Case Presentation: At age 14.5, the patient embarked on an effort to "eat healthy." She quickly lost control of the dieting, developed associated compulsions and obsessions about food, body dissatisfaction, emotional lability, and lost nearly 13.6 kilograms (30 pounds). She was hospitalized for 6 weeks, and while she regained some weight, she did not attain full weight restoration. For 15 years, she continued to eat in a restrictive manner, exercise compulsively, and have intermittent periods of alcohol dependence. Nevertheless, she always hoped to get well, and at age 29, she began a novel treatment for anorexia nervosa. Conclusions: This is the first report of a ketogenic diet used specifically for the treatment of anorexia nervosa, followed by a short series of titrated IV ketamine infusions leading to complete remission of severe and enduring anorexia nervosa, with weight restoration, and sustained cessation of cognitive and behavioral symptoms, for 6 months. Although these treatments were used sequentially the relationship between these modalities, and possible synergy, is unclear, and deserves further study. Complete and sustained remission of chronic anorexia nervosa is quite rare, and the novel use of a ketogenic diet and IV ketamine treatment in this potentially lethal condition suggests avenues for further research, and hope for patients and their families.
International journal of psychiatry research, Nov 30, 2019
Background: Recent inpatient studies examining the effect of low-dose ketamine infusions in treat... more Background: Recent inpatient studies examining the effect of low-dose ketamine infusions in treatment resistant depression (TRD) have shown promising results in diminishing suicidal ideation (SI). We describe the efficacy of titrated serial ketamine infusions in stopping suicidal ideation and averting ER visits and hospitalizations in a large, naturalistic sample of adult and adolescent outpatients with TRD and complex psychiatric comorbidity in a real-world psychiatry outpatient practice. Methods: This is a retrospective chart review of 231 adults and adolescents presenting with TRD and complex psychiatric comorbidity in a large real-world psychiatry office practice with > 5400 visits/year. Each patient underwent a 60-90 min comprehensive consultation by the single treating psychiatrist. Appropriate patients were treated with 6 serial, titrated ketamine infusions (0.5-1.2 mg/kg within 40-50 min) over 2-3 weeks. PHQ-9 was obtained at baseline and before each infusion. The presence, frequency, and intensity of suicidality expressed in PHQ-9 Item 9 was analyzed over the treatment course and correlated to decrease in total PHQ-9. Suicides, suicide attempts, ER visits and hospitalizations were analyzed over the course of treatment and for an additional 4 weeks. Results: 64% of TRD patients presented with SI. There were no suicides, attempts, ER visits or hospitalizations in this large real-world cohort. SI markedly diminished in 79%, and ceased completely in 59%. Remission of SI was progressive, occurring after 1 infusion in 36%; the remainder required 3.1 infusions and an average dose of 0.75mg/kg for remission of SI. Suicidal patients experienced higher rates of response and remission of TRD than non-suicidal patients. Conclusion: This is the first report of serial titrated IV ketamine infusions in a real-world psychiatry office for adults and adolescents with TRD and complex psychiatric comorbidity to safely and rapidly treat severe suicidal ideation and avert suicide, ER evaluation and hospitalization. It represents the largest number of patients to date reported from a single site in studies of IV ketamine infusions for TRD and suicidality, and a potential breakthrough treatment option for psychiatrists to provide in the office.
comprehensive and well-integrated community-based system of psychiatric services has been develop... more comprehensive and well-integrated community-based system of psychiatric services has been developed in South-Verona since the Italian psychiatric reform. Using the South-Verona Psychiatric Case Register, we identified chronic psychiatric patients in the community over a dyear period after the reform. Six first-contact so&demographic variables (sex, age, marital status, living situation, education, occupational status) and two clinical variables (ICD-9 diagnosis and past history of state psychiatric hospital admission) were studied for these patients. Four full cohort-years of post-reform chronic patients were followed for a 2-year period to determine their subsequent patterns of care. Logistic analysis was used to examine the interaction of cohort-year with outcome and the above sociodemographic and clinical variables studied individually and in combination. We found that 36.4% of post-reform chronic patients in the community remained in long-term contact with psychiatric services for 2 years after they were first identified. Logistic analysis revealed that none of the sociodemographic and clinical variables studied individually or in combination were predictive of the probability of remaining in long-term contact with community psychiatric services.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
Purpose Anorexia nervosa (AN) is a severe psychiatric disorder, and shape and weight concerns are... more Purpose Anorexia nervosa (AN) is a severe psychiatric disorder, and shape and weight concerns are often chronic despite weight normalization. No specific treatments exist for those preoccupations that interfere with recovery and trigger relapse. A case study using a ketogenic diet followed by ketamine infusions led to sustained remission in one patient with chronic AN. Here we conducted an open-label trial to test whether this response could be replicated. Methods Five adults weight recovered from AN but with persistent eating disorder thoughts and behaviors adopted a therapeutic ketogenic diet (TKD) aimed at maintaining weight. After sustaining nutritional ketosis, participants received six ketamine infusions and were followed over 6 months. Results All participants completed the study protocol without significant adverse effects. Two participants maintained TKD for 8 weeks prior to ketamine infusions due to good behavioral response and remained on TKD. Three participants received ...
... 1-Bromobenzocyclobutene: A Convenient Entry into the Benzocyclobutene Ring System' Mark ... more ... 1-Bromobenzocyclobutene: A Convenient Entry into the Benzocyclobutene Ring System' Mark R. Decamp* and Lori A. Viscogliosi Department of Natural Sciences, University of Michigan-Dearborn, Dearborn, Michigan 48128 Received October 30, 1980 ... M.; Wojciechowski. ...
The frequent co-occurrence of alcoholism withserious mental illnesses (“dual diagnosis”)necessita... more The frequent co-occurrence of alcoholism withserious mental illnesses (“dual diagnosis”)necessitates that clinicians are able to recognize itspresence in people with disabling mental illnesses. This study demonstrates that professionals oftenmiss the diagnosis, but that their ability to detectalcoholism can be greatly enhanced by the use of asimple screening tool. Members of an urban psychosocial rehabilitation program who received psychiatrictreatment in an
Journal of the American Psychiatric Nurses Association, 2001
In the next two issues of the journal, Psychobiology Perspectives will feature content in a somew... more In the next two issues of the journal, Psychobiology Perspectives will feature content in a somewhat different area than previously covered here. We will examine the underlying biology of two sets of problematic side effects from one class of antidepressants, namely those with strong 5-HT2 antagonist properties. Although the mechanism of action of 5-HT2 antagonism has many benefits, it may also yield some untoward effects. Two of these
Journal of the American Psychiatric Nurses Association, 2001
August 2001 APNA Web site: www.apna.org 125 Editor’s Note: In this month’s Psychobiology Perspect... more August 2001 APNA Web site: www.apna.org 125 Editor’s Note: In this month’s Psychobiology Perspectives, the column turns its focus toward the management of iatrogenic effects related to antidepressant treatment. Somnolence as a consequence of antidepressant treatment is both common and potentially problematic among certain agents, namely the 5HT2 antagonists such as nefazadone, trazadone, and others. This somnolence is an early-onset, time-limited side effect but one that is often a harbinger of negative treatment outcome evidenced in self discontinuation of the medication. Such a trend toward early treatment discontinuation has implications for long-term management of depression and as such merits close attention and intervention. (1998) explored the response and discontinuation rates of newer antidepressants (e.g., nefazadone, mirtazapine, venlafaxine) as compared with agents that have been on the market for a longer period of time (e.g., tricyclics, selective serotonin reuptake inhibitors, nontricyclics). Studies in this meta-analysis included randomized controlled clinical trials in the treatment of depression. In each comparison, the author analyzed the heterogeneity of outcomes and computed the pooled odds ratio with a 95% confidence interval. The overall discontinuation rate in the newer antidepressant group was lower than that of the tricyclic group but not that of the nontricyclic and selective serotonin reuptake inhibitor (SRI) groups. Despite such findings, early-onset, treatment-emergent side effects continue to present a significant challenge to the successful completion of a given medication trial.
comprehensive and well-integrated community-based system of psychiatric services has been develop... more comprehensive and well-integrated community-based system of psychiatric services has been developed in South-Verona since the Italian psychiatric reform. Using the South-Verona Psychiatric Case Register, we identified chronic psychiatric patients in the community over a dyear period after the reform. Six first-contact so&demographic variables (sex, age, marital status, living situation, education, occupational status) and two clinical variables (ICD-9 diagnosis and past history of state psychiatric hospital admission) were studied for these patients. Four full cohort-years of post-reform chronic patients were followed for a 2-year period to determine their subsequent patterns of care. Logistic analysis was used to examine the interaction of cohort-year with outcome and the above sociodemographic and clinical variables studied individually and in combination. We found that 36.4% of post-reform chronic patients in the community remained in long-term contact with psychiatric services for 2 years after they were first identified. Logistic analysis revealed that none of the sociodemographic and clinical variables studied individually or in combination were predictive of the probability of remaining in long-term contact with community psychiatric services.
The authors critically review the literature describing the varied neuropsychiatric syndromes ass... more The authors critically review the literature describing the varied neuropsychiatric syndromes associated with systemic lupus erythematosus (SLE). Factors that have complicated the identification and treatment of affective, behavioral, and cognitive disturbances in these patents are identified, and the utility of various diagnostic interventions is examined. Finally, the authors outline the role of the consultation-liaison psychiatrist in the clinical management of the SLE patient with neuropsychiatric disturbances.
Background: Chronic anorexia nervosa is a tragic disease with no known effective pharmacological ... more Background: Chronic anorexia nervosa is a tragic disease with no known effective pharmacological or behavioral treatment. We report the case of a 29 year-old woman who struggled with severe and enduring anorexia nervosa for 15 years, and experienced a complete recovery following a novel treatment of adopting a ketogenic diet followed by ketamine infusions. Her remission has persisted for over 6 months. Case Presentation: At age 14.5, the patient embarked on an effort to "eat healthy." She quickly lost control of the dieting, developed associated compulsions and obsessions about food, body dissatisfaction, emotional lability, and lost nearly 13.6 kilograms (30 pounds). She was hospitalized for 6 weeks, and while she regained some weight, she did not attain full weight restoration. For 15 years, she continued to eat in a restrictive manner, exercise compulsively, and have intermittent periods of alcohol dependence. Nevertheless, she always hoped to get well, and at age 29, she began a novel treatment for anorexia nervosa. Conclusions: This is the first report of a ketogenic diet used specifically for the treatment of anorexia nervosa, followed by a short series of titrated IV ketamine infusions leading to complete remission of severe and enduring anorexia nervosa, with weight restoration, and sustained cessation of cognitive and behavioral symptoms, for 6 months. Although these treatments were used sequentially the relationship between these modalities, and possible synergy, is unclear, and deserves further study. Complete and sustained remission of chronic anorexia nervosa is quite rare, and the novel use of a ketogenic diet and IV ketamine treatment in this potentially lethal condition suggests avenues for further research, and hope for patients and their families.
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Papers by Lori Calabrese